Endotracheal and tracheostomy tubes are used to provide an airway in patients who do not have an adequate airway do due to medical conditions. An endotracheal tube is inserted through the mouth and larynx and into the trachea. Tracheostomy tubes are inserted through an incision just above the sternal notch.
With both types of tubes, an inflatable cuff is incorporated at the distal end of the tube that is present within the trachea. The cuff allows pressurization of the lungs during mechanical ventilation, and prevents aspiration of oral secretions and other contaminants into the lungs. The inflated cuff also helps secure the tube in position. A consequence of the inflated cuff is that secretions pool around the top of the cuff, where undesired bacteria may colonize. Microaspiration of these secretions around the cuff is a leading cause of ventilator-associated pneumonia in this patient population.